Chapter 5: EMT In Practice At The University Of California

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Introduced under the context of enterprise risk management (ERM), the University of California (UC) Health System has adopted comprehensive strategies to identify, assess, and mitigate risks across its extensive network of clinics, medical centers, and academic institutions. CAUTIOUSLY integrating technological tools, the organization employs an ERM information system (ERMIS) and dashboards tailored to monitor key performance indicators (KPIs) crucial for operational and clinical risk management. This report explores the UC’s ERM practices, including its policies, programs, and technological integration, as well as specific initiatives aimed at reducing risk and enhancing patient safety.

The University of California’s ERM framework is rooted in the COSO (Committee of Sponsoring Organizations of the Treadway Commission) Internal Control framework, reaffirmed since its formal adoption in 1995. This provides a structured approach to identifying risks, implementing controls, and monitoring outcomes aligned with organizational strategic goals. The recent appointment of a Chief Risk Officer (CRO), backed by extensive industry experience, underscores UC’s commitment to sophisticated risk governance, emphasizing continuous risk assessment and proactive management.

Technology plays a fundamental role in UC’s ERM strategy. The integration of ERMIS allows for real-time risk assessments, visualization of risk data through dashboards, and effective communication across various levels within the health system. These dashboards leverage KPIs and visual indicators to enhance clarity and prompt action, supporting the ongoing process of risk mitigation. Incident, event, and claim data feed into these dashboards, enabling UC to evaluate risk trends and respond accordingly.

Among UC’s notable risk reduction initiatives are the Premium Rebate Program and the Professional Liability Prescription Program (PLPP). These programs incentivize units within the health system to adopt effective risk reduction measures. The rebate program, for instance, rewards clinical units based on their success in decreasing the frequency and severity of risk-related incidents. Similarly, the PLPP encourages proactive risk management practices to reduce liabilities associated with professional and clinical services.

In partnership with the Center for Health Quality and Innovation, UC has launched initiatives targeting clinical harm reduction. This joint venture allocates up to $8 million toward projects aimed at improving surgical safety and patient outcomes, illustrating a strategic alignment of ERM with clinical quality improvement efforts. This integrated approach underscores the recognition that managing clinical risks directly enhances organizational resilience and patient safety.

The handling of Protected Health Information (PHI) is a critical component within UC’s ERM activities. The development of the PHI Value Estimator (PHIve), created in collaboration with Bickmore, exemplifies how technological tools help quantify the impact of PHI breaches. It assesses potential legal, regulatory, financial, and reputational repercussions, empowering UC to better understand vulnerabilities and prioritize mitigation efforts.

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Enterprise Risk Management (ERM) at the University of California (UC) Health System exemplifies a forward-thinking approach to safeguarding the institution's extensive clinical, educational, and operational activities. The complexity of healthcare delivery inherently involves numerous risks—clinical, financial, operational, legal, and regulatory—that must be systematically identified, evaluated, and mitigated to ensure the safety of patients, staff, and the organization as a whole.

Fundamentally, UC's ERM strategy relies on integrating established frameworks such as COSO's Internal Control model, which provides a structured process for risk oversight. Since its adoption in 1995, UC has continuously evolved its ERM practices, emphasizing a proactive culture where everyone is considered a risk manager. This cultural shift emphasizes shared responsibility and promotes risk awareness throughout the organization, fostering an environment where risks are addressed at all levels.

Technology underpins UC’s ERM operations. The deployment of ERMIS, an innovative risk management information system, enhances data collection, analysis, and visualization. Dashboards displaying KPIs and visual indicators enable risk managers to track clinical incidents, operational failures, and compliance issues in real time. This technological integration facilitates rapid decision-making, enabling timely interventions that mitigate potential harm and financial loss.

One of UC’s prominent programs is the Premium Rebate Program, designed to incentivize clinical units and departments to implement effective risk mitigation initiatives. By rewarding units for success in reducing incident severity and frequency, UC promotes a culture of continuous improvement and accountability. Similarly, the Professional Liability Prescription Program (PLPP) encourages staff to engage in practices that lower professional liability risks, aligning individual and organizational goals around patient safety and quality care.

Additionally, UC collaborates with the Center for Health Quality and Innovation to fund projects that directly tackle clinical risks. These initiatives, supported by grants of up to $8 million, focus on reducing surgical complications and enhancing patient safety. They exemplify how ERM activities extend beyond compliance, actively contributing to clinical excellence and organizational resilience.

Managing Protected Health Information (PHI) constitutes another critical aspect of UC’s ERM framework. The development of the PHI Value Estimator (PHIve), a software tool created in partnership with Bickmore, illustrates a strategic approach to risk quantification. By estimating the potential impact of PHI breaches—including legal penalties, financial losses, and reputational damage—UC can prioritize mitigation efforts effectively. This tool exemplifies how technological innovation enhances risk assessment capabilities, ensuring that sensitive information remains protected.

UC’s ongoing commitment to refining and expanding its ERM practices demonstrates an organizational recognition that risk management is integral to sustaining high-quality, safe, and compliant healthcare delivery. Its use of sophisticated systems, incentive programs, and collaboration with innovation centers indicates a holistic approach aligned with best practices in healthcare risk management. Moreover, UC’s strategic integration of technology ensures that risk data is not only collected but actively leveraged to support continuous improvement.

Adopting a comprehensive ERM framework yields multiple benefits for UC, including improved patient safety, regulatory compliance, and operational efficiency. It fosters a culture where risks are explicitly acknowledged and managed, ultimately reducing the likelihood of adverse events and associated costs. As healthcare organizations face increasing complexities and regulatory scrutiny, UC’s model serves as an exemplar of how enterprise risk management, supported by technology and organizational commitment, can enhance resilience and promote sustainable growth.

References

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• University of California. (2022). UC Health risk management program overview. UC Office of Risk Services.
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• Centers for Medicare & Medicaid Services. (2021). Protecting patient health information. CMS Policy Manual.
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• Institute of Medicine. (2011). Improving diagnosis in health care. The National Academies Press.
• Porozzolo, T. (2018). Clinical risk management: strategies and tools. Medical Practice Management, 11(4), 32–36.
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• McKinsey & Company. (2019). Technology's role in healthcare risk management. McKinsey Insights.
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